Leeches have been used since antiquity for therapeutic purposes. Throughout history, the leech has enjoyed periods when it has been in favour in France – during the 19th century in particular – but also periods during which it has been abandoned and even the subject of denigration. In recent years, leeches have grown in popularity once again for use in plastic surgery and traumatology and they have also made a return in the field of traditional medicine.
Antiquity / Middle-Ages
The oldest traces of the use of leeches seem to date back to ancient times, to at least 1600-1300 BC. A mural painting depicting the application of leeches has been uncovered inside a tomb in Thebes (Egypt) from the 18th dynasty.
The use of leeches was also described by Greeks and Latin writers from Antiquity (PLAUTUS, CICERO, HORACE) under the name of bdella, sanguisuga or hirudo.
In Greece, NICANDER of Colophon (185-138 BC) and in Rome, THEMISON of Laodicea (123-43 BC) appear to have been the first to recommend the therapeutic use of leeches. PLINY the Elder (23 to 79 AD.) was already recommending their use in the treatment of phlebitis and haemorrhoids.
At the end of the Middle-Ages, doctors were treating numerous illnesses with leeches. Towards the middle of the 16th century, Conrad GESSNER of Zurich gave a detailed description of the medical leech and advocated its use. In the 17th century, bleeding was carried out using lancets and the use of leeches remained marginal. During this period, however, Jérôme NEGRISOLI published a work on the application of leeches in the field of gynaecology.
From the 17th to the 19th century
In the 18th century, leeches came back into favour, particularly in the treatment of phlebitis and haemorrhoids. During the Revolution, a lack of surgeons meant they were used for bleeding purposes.
In the 19th century, various monographs were published on leeches. In 1809, VITET, author of the “Treaty of Medical Leeches” declared: “the benefits of the leech for man are so great that all doctors should be aware of them”. The leech was once again considered to be a unique therapeutic tool. The influence of BROUSSAIS (1772-1838), a surgeon in the Napoleonic army, was decisive for the leech and the market for them. France became the biggest consumer of leeches of the time. BROUSSAIS’ motto was: “Given that most diseases are caused by hyper-stimulation, often an inflammation of the stomach, they should be treated by controlling the inflammation, i.e. via the application of leeches on the abdomen and a strict diet”. From 1822, BROUSSAIS published the Annals of Medicine, a monthly journal that ran for 12 years, enabling him to spread his doctrine throughout Europe. The quantity of annelids used between the 1830s and 1840s was said to have been around 60 million per year. At the same time, Russia consumed 30 million leeches annually for the treatment of a variety of disorders, ranging from tuberculosis to epilepsy and rheumatism.
The large scale use of leeches gradually led to the depopulation of French marshland. Initially, France turned to neighbouring countries. But they too would soon run out and France then went further afield to find the precious worm in Hungary, Poland, Greece and Turkey. In order to increase their profits, in 1827 some companies began to export leeches that had either been imported or produced by hirudiniculture. Thanks to improvements in transport, the leech trade became global at this point. However, exports remained well below imports, with leeches mostly being exported to Spain, Belgium, French Overseas Territories, England, Switzerland, the United States, Brazil and the German Confederation. The United States represented major customers for Europe since they were unable to produce European leeches and bred the Hirudo decora, which did not deliver a big enough or deep enough incision.
In 1835, the American government even offered a subsidy of 500 dollars to anyone who could successfully breed the European leech.
At the same time, with a view to managing this flourishing market, breeding had begun in the Gironde, a region that was ideally suited to such an activity, given the abundance of leeches present there. The BECHADEs, a farming family in the region, had solved the main problem associated with leech breeding: feeding. They had realised, thanks to a fortuitous combination of circumstances, that leeches emerged when sick horses were being walked in the marshes, hence the idea of feeding the annelids with these animals. The BECHADE’s business expanded and their success encouraged others to copy them. In 1854, hirudiniculture in the Gironde extended over an area of 5,000 hectares, a significant proportion of which was devoted to horse grazing. Unfortunately, this lucrative business encouraged the development of fraudulent activities, leeches gorged with blood to increase their weight, the sale of leeches unfit for use and of poor quality.
The Gironde public health and hygiene committee was faced with the dual problem of not compromising public health and protecting an industry that could provide a number of benefits. Health problems associated with returning water to marshland and the management of sick horses began to appear in breeding areas. At the same time, the excessive use of leeches leading to interminable convalescences, haemorrhages and skin infections led to BROUSSAIS’ doctrine – and consequently leeches themselves – being discredited. After the 1850s, leech breeding was abandoned by most people; with production being surplus to demand and competition from countries such as Hungary and Turkey, prices collapsed. Following the cholera epidemic of 1832 and the development of aseptic techniques by Pasteur, doctors rejected the use of leeches, now considered to be carriers of germs. The leech went into a period of decline.
Thereafter, the lack of livestock as well as labour during the First World War exacerbated this decline in French production and led to hirudiniculture being abandoned. The marshes dried up and this, combined with the use of pesticides and herbicides, made it impossible for leeches – highly sensitive to water quality – to survive.
From the 20th century to today
In 1938, they disappeared from the French pharmacopoeia and consequently from pharmacies in France, as they did in neighbouring countries. Nevertheless, they were still used in medical practice; in 1949, an article recommended them for visceral congestion, pericarditis, myelitis, laryngeal oedema, angina pectoris, hemiplegia, other congestive and inflammatory disorders (headaches, dizziness, otitis, sprains and dislocations, contusions, etc.
New emerging concepts in the field of medicine tainted their reputation with both therapists and patients alike and the animal almost completely disappeared from the therapeutic setting with the development of new drugs by the pharmaceutical industry. However, the Vidal French drug compendium of 1960 continued to devote a full page to the therapeutic indications for medical leeches sold by Etablissements R.D.B in Audenge in the Gironde region.
From 1972, their use was no longer covered by the French Social Security system. But at the same time, leeches were beginning to find favour again in the medical field, and, more specifically, in surgery. Plastic surgery and traumatology departments in hospitals and clinics began to use them.
The leech has become a topical issue once again since GPs been turning increasingly to the animal for the treatment of various disorders: phlebitis, arthritis, blood poisoning, etc. The problem is that the leech has found it difficult to establish a position for itself in the lobbying of the pharmaceutical and drug industries. On this subject, in December 2004, a French MP from the Lorraine region, J-L. MASSON, questioned the health minister about the fact that leeches, recommended for the previous few years for a range of ailments, were no longer reimbursed. The minister replied that given that leeches were “living creatures”, they could not be considered to be “products” and consequently could not be reimbursed. The only possible exception to this would be to reimburse a therapeutic procedure relating to their application.
In recent years, the pharmaceutical industry and scientific laboratories have been focusing on the extraordinary powers of leeches. Given its qualities in the field of general medicine, its unrivalled role in surgery and the properties of its saliva and nervous system, the leech is invaluable to the development of cutting-edge techniques in modern medicine.
Today, RICARIMPEX is the only French structure to pursue this long tradition of hirudiniculture in the Gironde.